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J Pediatr Intensive Care 2017; 06(03): 159-164
DOI: 10.1055/s-0036-1596064
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Catheter-Associated Blood Stream Infections in Intracardiac Lines

Xiomara Garcia
1   Pediatric Critical Care Medicine and Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Sherry Pye
2   Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Xinyu Tang
3   Pediatrics-Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Jeffrey Gossett
3   Pediatrics-Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Parthak Prodhan
1   Pediatric Critical Care Medicine and Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Adnan Bhutta
4   Pediatric Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
› Institutsangaben
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Publikationsverlauf

20. Juni 2016

22. Oktober 2016

Publikationsdatum:
05. Dezember 2016 (online)

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Abstract

Purpose Right atrial (RA) or intracardiac lines are commonly used for hemodynamic monitoring in children undergoing cardiac surgery. In some institutions, these lines are used as the preferred long-term access line due to concerns for catheter-associated blood stream infections (CABSI) and catheter-related venous thrombosis with central lines in other locations. However, the rates and risk factors for CABSI and other complications are not known for RA lines. We undertook this study to estimate CABSI rates for RA lines in comparison with central catheters of various types and locations and to evaluate the incidence of other complications associated with the use of RA lines.

Methods After approval from the Institutional Review Board, a retrospective review of all patients undergoing cardiac surgery at Arkansas Children's Hospital between the dates of January 1, 2006 and December 31, 2011 was performed. Demographic data, clinical features, and outcomes were summarized on a per-patient level. Type, location of placement, and duration of all centrally placed catheters as well as associated complications were recorded. Central venous lines (CVL) used in our unit include peripherally inserted central catheters (PICC) lines, and antibiotic and heparin coated double or triple lumen lines placed in internal jugular (IJ), femoral (Fem), or RA positions. The data were analyzed using statistical software STATA/MP.

Results A total of 2,736 central lines were used in 1,537 patients. Data on line duration, alteplase use, and percentage of lines developing CABSI are described in the study. Disease severity as assessed by risk-adjusted classification for congenital heart surgery (RACHS) score (p < 0.046), year of placement (p < 0.001), and line type adjusted for thrombolytic (alteplase) use are significantly associated with risk of any CABSI. Overall, IJ and RA lines had least risk of CABSI while PICC lines had the highest CABSI rates. RA lines are also associated with other medically significant complications.

Conclusion The CABSI rates associated with RA lines are lower than those seen with PICC lines. However, RA line use is associated with other, potentially significant complications. RA lines may be used cautiously as long-term access lines in cardiac patients in whom it is important to preserve venous patency for future interventions.

Keywords

alteplase - intracardiac lines - right atrial lines - peripherally inserted central catheters - catheter-associated blood stream infections - risk-adjusted classification for congenital heart surgery